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The Efficacy of Playing Musical Instruments for Upper Limb Rehabilitation among Individuals with Stroke: A Systematic Review
Systematic/Meta-Analytic Review Posters Systematic & Meta-Analytic Review Poster 377 Safe Landing Strategies During a Fall: Systemic Review and Meta-Analysis Yaejin Moon (University of Illinois at Urbana-Champaign), J.J. Sosnoff Objectives: To systematically synthesize information on safe landing strategies during a fall and quantitatively examine the effects of the strategies to reduce risk of injury from a fall. Data Sources: PubMed, Web of science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Study Selection: Databases were searched using the combinations of keywords of “falls”, “strategy”, “impact” and “load”. Randomized control trials, cohort studies, pre-post studies, or cross-sectional studies were included. Data Extraction: The fall strategies were extracted and categorized by falling direction. Measurements of impact loads that reflect the risk of injuries were extracted (e.g. impact velocity, impact force, fall duration, and impact angle). Hedges g was used as effect size to quantify effect of a protective landing strategy to reduce the impact load. Data Synthesis: A total of seven landing strategies (squatting, elbow flexion, forward rotation, martial arts rolling, martial arts slapping, relaxed muscle, and stepping) in 13 studies were examined. In general, all strategies, except for the martial arts slapping technique, significantly reduced impact load (g’sZ0.73 to 2.70). Squatting was an efficient strategy to reduce impact in backward falling (gZ1.77) while elbow flexion with outstretched arms was effective in forward falling (gZ0.82). Also, in sideways falling strategies, martial arts rolling (gZ2.70) and forward rotation (gZ0.82) were the most efficient strategies to reduce impact load. Conclusions: The result showed that landing strategies have significant effect on reducing impact load during a fall and might be effective to reduce injury risk of falling. The current study also highlighted limitations of the previous studies which focused on a young population and self-initiated falls. Further investigation with elderly individuals is necessary to verify effectiveness and suitableness of the strategies to atrisk population. Key Words: Falls, Impact, Strategy, Injury Disclosures: None disclosed. Systematic & Meta-Analytic Review Poster 406 Systematic Review of Exercise, Physical Activity, and Physical Fitness Effects on Cognition in Persons with Multiple Sclerosis Brian Sandroff (The Chicago School of Professional Psychology), Robert W. Motl, Mark R. Scudder Objectives: To perform a systematic, evidence-based review on the existing literature on exercise, physical activity, and physical fitness effects on cognition in MS to accurately describe the current status of the field, offer recommendations for clinicians, and provide future direction for ongoing MS research. Data Sources: An open search of Medline, PsychInfo, and CINAHL was performed using combinations of exercise, physical activity, physical fitness, aerobic, resistance, balance, walking, yoga, multiple sclerosis, training, and rehabilitation, as search terms. Reference sections of selected articles further were reviewed. Study Selection: Articles were eliminated from the review if it was a review article, theoretical paper, or textbook chapter; did not involve persons with MS; involved only persons with pediatric-onset MS; did not involve neuropsychological outcomes; did not include empirical data to evaluate outcomes; involved pharmacological interventions; or was not available in English. Data Extraction: Articles were categorized based on examinations on the effects of exercise, physical activity, or physical fitness on cognition in MS. The selected articles were then randomly assigned to 4 reviewers. Each study was fully-reviewed by 2 independent
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e143 reviewers and was rated for level of evidence according to predetermined criteria. Data Synthesis: The present review resulted in 26 studies on the effects of exercise, physical activity, and physical fitness on cognition in persons with MS. This included 1 Class-I study, 3 Class-II studies, 8 Class-III studies, and 14 Class-IV studies. Conclusions: Overall, there is insufficient well-designed research to definitively conclude that exercise, physical activity, and physical fitness are effective for improving cognition in MS. This is based, in part, on methodological issues of Class-I and Class-II studies. However, promising evidence from Class-III and Class-IV studies may be useful for informing the development of better intervention research. Key Words: Exercise, Physical Activity, Physical Fitness, Cognition, Multiple Sclerosis Disclosures: BMS is a postdoctoral fellow funded by the National Multiple Sclerosis Society (grant # MB0024) to JDL. All other authors declare no conflicts of interest. Systematic & Meta-Analytic Review Poster 442 The Efficacy of Playing Musical Instruments for Upper Limb Rehabilitation among Individuals with Stroke: A Systematic Review Amanda McIntyre (Parkwood Institute), Josh Brar, Andreea Cotoi Objectives: To conduct a systematic review on the use of musical instruments as a form of upper limb rehabilitation in individuals post stroke and to assess its effectiveness in improving motor outcomes. Data Sources: PubMed, Scopus, EMBASE, PsycINFO and ProQuest databases were searched for all relevant articles published in English up to January 2016. Study Selection: Studies were reviewed and included in the analysis if: 1) the study population was >50% adult patients with stroke; 2) the sample size was 3; 3) the intervention group received musical therapy using physical or virtual instruments; and 4) upper limb motor outcomes were evaluated. Data Extraction: Patient characteristics, study design, motor outcome measure(s) used, and results were extracted. Study quality was assessed using the PEDro assessment scale for randomized controlled trials (RCTs). Levels of evidence were assigned to the interventions using a modified Sackett scale. Data Synthesis: A total of 15 articles met inclusion, consisting of 8 RCTs, 2 prospective controlled trials and 5 pre-post trials. Five studies used a MIDI virtual piano and electronic drum set, four studies used only percussion instruments, three studies used only a keyboard, two studies used a mechanical virtual reality system and one study used the musical sonification of gross arm movements. Eight studies reported significant improvements on motor outcomes including the action research arm test (nZ4), box and block test (nZ4) and 9 hole pegboard test (nZ4). Conclusions: Results showed that the playing of musical instruments was an effective method of upper limb rehabilitation following stroke. It is important to note that five studies demonstrating motor improvements provided musical therapy in conjunction with conventional rehabilitation therapy. Future studies should assess musical playing as a standalone treatment. Key Words: Stroke, Music Therapy, Upper Extremity Disclosures: None disclosed. Systematic & Meta-Analytic Review Poster 443 Pharmacological Management of Agitation Among Individuals with Moderate to Severe Acquired Brain Injury: A Systematic Review Swati Mehta (Parkwood Institute), Shannon Janzen, Amanda McIntyre Objectives: To conduct a systematic review examining the effectiveness of pharmacological management of agitation among individuals with acquired brain injury (ABI).
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e143 reviewers and was rated for level of evidence according to predetermined criteria. Data Synthesis: The present review resulted in 26 studies on the effects of exercise, physical activity, and physical fitness on cognition in persons with MS. This included 1 Class-I study, 3 Class-II studies, 8 Class-III studies, and 14 Class-IV studies. Conclusions: Overall, there is insufficient well-designed research to definitively conclude that exercise, physical activity, and physical fitness are effective for improving cognition in MS. This is based, in part, on methodological issues of Class-I and Class-II studies. However, promising evidence from Class-III and Class-IV studies may be useful for informing the development of better intervention research. Key Words: Exercise, Physical Activity, Physical Fitness, Cognition, Multiple Sclerosis Disclosures: BMS is a postdoctoral fellow funded by the National Multiple Sclerosis Society (grant # MB0024) to JDL. All other authors declare no conflicts of interest. Systematic & Meta-Analytic Review Poster 442 The Efficacy of Playing Musical Instruments for Upper Limb Rehabilitation among Individuals with Stroke: A Systematic Review Amanda McIntyre (Parkwood Institute), Josh Brar, Andreea Cotoi Objectives: To conduct a systematic review on the use of musical instruments as a form of upper limb rehabilitation in individuals post stroke and to assess its effectiveness in improving motor outcomes. Data Sources: PubMed, Scopus, EMBASE, PsycINFO and ProQuest databases were searched for all relevant articles published in English up to January 2016. Study Selection: Studies were reviewed and included in the analysis if: 1) the study population was >50% adult patients with stroke; 2) the sample size was 3; 3) the intervention group received musical therapy using physical or virtual instruments; and 4) upper limb motor outcomes were evaluated. Data Extraction: Patient characteristics, study design, motor outcome measure(s) used, and results were extracted. Study quality was assessed using the PEDro assessment scale for randomized controlled trials (RCTs). Levels of evidence were assigned to the interventions using a modified Sackett scale. Data Synthesis: A total of 15 articles met inclusion, consisting of 8 RCTs, 2 prospective controlled trials and 5 pre-post trials. Five studies used a MIDI virtual piano and electronic drum set, four studies used only percussion instruments, three studies used only a keyboard, two studies used a mechanical virtual reality system and one study used the musical sonification of gross arm movements. Eight studies reported significant improvements on motor outcomes including the action research arm test (nZ4), box and block test (nZ4) and 9 hole pegboard test (nZ4). Conclusions: Results showed that the playing of musical instruments was an effective method of upper limb rehabilitation following stroke. It is important to note that five studies demonstrating motor improvements provided musical therapy in conjunction with conventional rehabilitation therapy. Future studies should assess musical playing as a standalone treatment. Key Words: Stroke, Music Therapy, Upper Extremity Disclosures: None disclosed. Systematic & Meta-Analytic Review Poster 443 Pharmacological Management of Agitation Among Individuals with Moderate to Severe Acquired Brain Injury: A Systematic Review Swati Mehta (Parkwood Institute), Shannon Janzen, Amanda McIntyre Objectives: To conduct a systematic review examining the effectiveness of pharmacological management of agitation among individuals with acquired brain injury (ABI).